HomeMy WebLinkAbout108976 L & M ENTERPRISES INC - INSURANCE CERTIFICATEACORD CERTIFICATE OF LIABILITY INSURANCE
*M1
F DATE(MMfDD/YYYY)
12/15/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
Ewing -Leavitt Insurance Agency
4025 St. Cloud Dr.
Suite 100
Loveland, CO 8OS38
CONTANAME: Renee McReynolds
PA"OFAX
ONeEat:970.679.7344 AC.Np:866.42S.6180
AODREss: renee-mcreynolds@leavitt.com
INSURER(S) AFFORDING COVERAGE
NAIC It
INSURER A: Cincinnati Insurance Co
10677
INSURED L & M Enterprises Inc
P 0 BOX W
735 E. Highway 56
Berthoud CO 80513
INSURERB: Commerce and Industry Ins Co
19410
INSURER C:
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1S-16 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
POLICY EFF
MMIDDNYYY
POLICY IcXP
MMIDDIYYYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FxIOCCUR
X Blkt WOS
ENP0224898
ADDL INSURED FORM INCL
ONGOING AND COMPLETED
OPERATION
01/01/2015
01/01/2016
EACH OCCURRENCE
$ 1,000,000
PREMISES Ea occurrence
$ 500,000
MED EXP (My one Person)
$ 10,00
PERSONAL BADVINJURY
X
Blkt Addl Insureds
GENERAL AGGREGATE
GEN'L AGGREGATE LIMIT APPLIES PER:
X PROLOC JECTAUTOMOBILE
PRODUCTS-COMP/OP AGGPOLICY
W2,000,000
A
UABIUTY
ANY AUTO
ALL AUTOS NED AUTOESULED
NON_ONED
AUTOS
AUTOS NX
Blkt WOS Blkt AI
ENP022489
01/01/2015
01/01/2016
Eaacchfem
BODILY INJURY(Per person)
BODILY INJURY(Per accident)HIRED
Per accident
X
$
A
X
UMBRELLALMB
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
ENP022489
01/01/2015
01/01/2016
EACH OCCURRENCE
$ 3,000,000
AGGREGATE
$ 3,000,000
DIED I X I RETENTIONS C
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIV YIN
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N I A
WC01939721
INCL BLANKET WAIVE
OF SUBROGATIO
01/01/2015
01/0112016
X W
TORY LIMITS ER
E.L. EACH ACCIDENT
Is 1,000,000
E.L. DISEASE -EA EMPLOYE
$ 1:000,0Q
E.L. DISEASE -POLICY LIMIT
$ 1, 000,000
A
ontractors' Equipment
$8S,000 Installation
Floater
FNP0224898
01/01/2015
01/01/2016
Leased/Rented Equipment
$150,000 limit - $1000 deduct
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule. If more space Is required)
e: 8016 SH392 & I-25 Community ID Signs
Certificate holder is named additional insured as respects both general and auto liability
policies.
CERTIFICATE HOLDER CANCELLATION
City of Fort Collins
P 0 Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
CORPORATION. All
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD